[P198] An atypical histopathologic finding of Spitz nevus showing many horn cysts

( Si Hyub Lee ),( Ji Hye Heo ),( Hee Seong Yoon ),( Seung Dohn Yeom ),( Ji Won Byun ),( Gwang Seong Choi ),( Jeonghyun Shin ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Spitz nevus is a benign melanocytic nevus, usually presenting as a single, dome-shaped papule or nodule. It commonly involves the face and lower extremities in children or young adults. The characteristic histopathologic findings are uniformed nests of spindle shaped and epithelioid melanocytes from epidermis to the reticular dermis. We report a case of a 21-year-old healthy man presented with a solitary 7mm-sized erythematous dome-shaped papule on the right cheek. He had been previously treated for the lesion with herbal acupuncture at an Oriental medicine clinic, and it had no therapeutic effect. We excised the lesion with carbondioxide LASER and the histopathologic examination of the specimen showed nests of epithelioid and spindle shaped melanocytes extending from the dermo-epidermal junction to the reticular dermis with clefts at the interface between the nests and the hyperplastic epidermis. Maturation of the nevus cells was seen as descending into the dermis. Pagetoid spreading into epidermis, cellular atypia, or mitosis were not seen. In addition to the usual histopathologic findings of Spitz nevus, the lesion revealed many horn cysts in the epidermis. To the best of our knowledge, this is the first case report on Spitz nevus accompanied by numerous horn cysts.

Histopathological and immunohistochemical analysis of rosacea: the role of the sebaceous gland in the pathogenesis of rosacea

( Si Hyub Lee ),( Seon Bok Lee ),( Ji Hye Heo ),( Hee Seong Yoon ),( Seung Dohn Yeom ),( Ji Won Byun ),( Gwang Seong Choi ),( Jeonghyun Shin ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Rosacea affects primarily the central face which is densely populated with sebaceous glands. The pathogenesis of rosacea is not fully understood but it may involve aberrant immune pathways, neurovascular dysregulation, and microorganisms. Objectives: This study investigated the histopathological and immunohistochemical (IHC) features of rosacea, and is to know the pathogenesis of rosacea. Methods: Histopathological features of 6 erythematotelangiectatic rosacea (ETR) and 22 papulopustular rosacea (PPR) patients, were retrospectively evaluated. We also analyzed IHC findings of TLR-2, LL-37, TRPV2, and TRPV4 in 6 ETR and 16 PPR patients, and compared with 8 skin samples of normal controls. Results: Telangiectasia, perivascular and perifollicular lymphohistiocytic infiltrates were common findings of rosacea. Epidermal expression of TRPV2 and TRPV4 were stronger in ETR than in PPR. Epidermal expression of LL-37 in both ETR and PPR have higher intensity than normal control. We observed lymphohistiocytic infiltrates around sebaceous glands in almost all the patients. Increased mast cells were also found around sebaceous glands. Conclusion: ETR and PPR showed common histopathologic findings, however, the IHC data suggest they have somewhat different pathogenic pathways in the complex interplay of neurovascular dysregulation and aberrant immune system. We also demonstrated some microscopic findings of sebaceous gland that suggest its role in the chronic inflammatory process of rosacea.

A case of BCG granuloma mimicking pyogenic granuloma

( Si Hyub Lee ),( Seung Dohn Yeom ),( Hye Soo Ko ),( Jong Hyuk Moon ),( Ji Won Byun ),( Gwang Seong Choi ),( Jeonghyun Shin ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Bacillus Calmette-Guerin(BCG) is a live attenuated vaccine derived from Mycobacterium bovis. BCG vaccination can induce various dermatological complications including scar, abscess and granulomatous diseases such as lupus vulgaris. BCG granuloma is a rare complication of BCG vaccination, and the treatment method of it is not yet clearly defined. A 6-month-old male infant presented with an easily bleeding nontender erythematous protruding mass developed over a BCG injection site on his left shoulder after the first BCG immunization. There was no past or family history of Kawasaki’s disease, tuberculosis and immunodeficiency. A punch biopsy was done and histopathological examination showed chronic non-caseating granulomatous inflammation with microabscess formation. BCG granuloma was diagnosed and we treated the lesion with shave excision. The wound was clear and no recurrence is identified until 4 months after excision.

A case of erythromelalgia on the left chest associated with syringomyelia

( Si Hyub Lee ),( Hee Seong Yoon ),( Seung Dohn Yeom ),( Hye Soo Ko ),( Ji Won Byun ),( Gwang Seong Choi ),( Jeong Hyun Shin ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Erythromelalgia is a rare clinical syndrome characterized by episodic intense burning pain with marked erythema, which is triggered by heat exposure or exercise. It commonly involves the feet and hands, and it may also occur on the face or ear. The etiology of erythromelalgia remains unknown and it can present as a primary or secondary to a variety of conditions including myeloproliferative, autoimmune diseases and neuropathic disorders. The histopathologic findings are often nonspecific. Diagnosis of erythromelalgia is based on the clinical findings and potential secondary causes must be excluded. The natural clinical course of erythromelalgia is variable. Although numerous therapeutic regimens have been described, the optimal therapy is unclear. Herein, we report a case of a 74-year-old woman with erythromelalgia on her left chest. She had a syringomyelia, and the sensory neural function of the left neck and chest was decreased. To our best knowledge, this is the first case of erythromelalgia occurred on the chest in Korean literature.

A case of staphylococcal scalded skin syndrome in adult

( Si Hyub Lee ),( Seon Bok Lee ),( Ji Hye Heo ),( Hee Seong Yoon ),( Seung Dohn Yeom ),( Ji Won Byun ),( Jeonghyun Shin ),( Gwang Seong Choi ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Staphylococcal scalded skin syndrome (SSSS) is an extensive desquamative erythematous dermatosis caused by remote produced and hematogenous circulating exfoliative toxins produced by Staphylococcus aureus. It is clinically characterized by tender diffuse erythematous eruption followed by the development of flaccid bullae that typically exhibit a positive Nikolsky sign involving the periorificial face, neck, axillae, trunk and groins with sparing of the mucous membranes.SSSS is a condition that predominantly affects young children and neonates, in whom the prognosis is quite favorable. It rarely occurs in adults, usually in association with renal insufficiency, malignancy or immunosuppression. In contrast to pediatric cases, the mortality rate of adult is high due to concomitant morbidity factors and increased likelihood of sepsis. Herein, we report a complicated case of staphylococcal scalded skin syndrome in an adult associated with methicillin-resistant Staphylococcus aureus which have difficulty in treating with antibiotics.

A case of Sweet syndrome preceded juvenile rheumatoid arthritis

( Si Hyub Lee ),( Hee Seong Yoon ),( Seung Dohn Yeom ),( Hye Soo Ko ),( Ji Won Byun ),( Gwang Seong Choi ),( Jeonghyun Shin ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Sweet syndrome is characterized by abrupt onset of fever, leukocytosis, tender erythematous plaques or nodules, and dermal neutrophilic infiltration that typically respond to systemic corticosteroids. It is often associated with underlying inflammatory, malignant, or autoimmune diseases. We report a case of a 9-year-old girl who had recurrent fever unresponsive to antibiotics and presented with pruritic and tender dusky erythematous annular patches with some small flaccid vesiculopustules over the whole body. Tzanck smear, Gram’s stain and culture on the vesicular lesions were negative. Skin biopsy showed subepidermal separation and perivascular neutrophilic infiltration without vasculitis. Immunofluorescence stains for IgG, IgA, IgM, C3, and C4 were all negative. She was diagnosed with Sweet syndrome and investigated underlying diseases. The hematologic examinations were not remarkable, however high erythrocyte sedimentation rate and presence of autoantibodies made us to suspect underlying autoimmnune disorders. The skin lesion and fever had good responses to systemic steroids, but recurred on tapering. After changing the medication with dapsone as alternatives, the entire skin lesion disappeared with no side effects. While on follow up, she complained migrating arthralgia on multiple joints and was referred to a pediatric rheumatologist. Finally she was diagnosed with juvenile rheumatoid arthritis.

[P053] A case of solitary adult type cutaneous myofibroma on the finger

( Si Hyub Lee ),( Ji Hye Heo ),( Hee Seong Yoon ),( Seung Dohn Yeom ),( Ji Won Byun ),( Gwang Seong Choi ),( Jeonghyun Shin ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Myofibroma is an uncommon, benign myofibroblastic neoplasm, mostly occurring on the skin. It can also involve skeletal muscles, bones, or viscera. Although adult-onset myofibroma shows histopathological similariry to infantile myofibromatosis, it has a distinct clinical feature compared with the infantile form. It is exclusively solitary, and usually affect the skin of head and neck, confined to the dermis and subcutaneous layer. Histopathologically, uncapsulated tumor in dermis consists of spindle shaped cells arranged in whorls or interlacing fascicles. The cytoplasms of the spindle shaped cells have fuchsinophilic appearance in Masson`s trichrome staining. Tumor cells show immune-reactivity to smooth muscle actin and vimentin, but negative to desmin and S-100. It does not regress spontaneously, but has benign clinical course with very rare recurrence after surgical treatment. Herein, we report a case of a solitary skin-colored hard keratotic papule that developed on the distal phalangeal joint area of left finger in a 58-year-old man. The tumor was diagnosed as cutaneous myofibroma by histopathologic examination and immunohistochemical stainings. This is the first case report about solitary cutaneous myofibroma of the finger in Korean dermatologic literature. The clinical manifestation of the lesion could be easily misdiagnosed as wart.

[P052] A case of familial acral acanthosis nigricans

( Si Hyub Lee ),( Ji Hye Heo ),( Hee Seong Yoon ),( Seung Dohn Yeom ),( Jeonghyun Shin ),( Gwang Seong Choi ),( Ji Won Byun ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Acanthosis nigricans is a symmetric eruption characterized by a hyperpigmented, velvety cutaneous thickening that commonly affects the nape and flexural area of the body, typically on the axillae and groin. But the velvety hyperkeratotic lesions can be localized to unusual sites, particularly over the elbows, knees, knuckles, and dorsal surfaces of the feet, with sparing axillae and other intertriginous regions, a variant of acanthosis nigricans called acral type acanthosis nigricans. Herein, we report a case of an obese 14-year-old boy presented with brownish hyperpigmented, hyperkeratotic plaques on the knuckles of both hands and dorsum of toes. The skin manifestation have appeared since birth, becoming apparent as he grew up. The patient said his grandfather, father, and uncle have similar lesions on the same area. Histopathological examination revealed acanthosis with papillomatosis and extensive hyperkeratosis. Considering clinical and histopathological findings, a diagnosis of acral acanthosis nigricans was made. When hyperkeratotic plaques appear on the elbows, knees, or extensor surface of feet, acral acanthosis nigricans should be considered as a possible diagnosis. To the best of our knowledge, this is the first case report of acral acanthosis nigricans with inherited patterns.

P086 Efficacy of combination therapy with diphenylcyclopropenone and anthralin in the treatment of severe alopecia areata

( Si Hyub Lee ),( Hee Seong Yoon ),( Seung Dohn Yeom ),( Hye Soo Ko ),( Ji Won Byun ),( Jeonghyun Shin ),( Gwang Seong Choi ) 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 extensive alopecia areata (AA), topical immunotherapy with diphenylcyclopropenone (DPCP) is recommended. However, DPCP treatment occasionally has some limitations in chronic extensive AA. Previous study reported combination therapy with DPCP and anthralin was superior to DPCP alone in chronic extensive AA. Objectives: We sought to identify the efficacy of combination therapy with DPCP and anthralin in the treatment of severe AA. Methods: 10 patients (5 female and 5 male, 8~48 years old, mean age 19.3 years) with chronic, treatment-refractory extensive AA who were treated with DPCP and anthralin from March 2014 were evaluated retrospectively. 4 patients were treated with DPCP only for at least 2 months before combination with anthralin, and 6 patients started combination therapy on the first visit. Results: Hair regrowth over 50% of scalp was observed in 3 patients (30% of the patients), with one complete hair regrowth (10% of the patients). 7 patients showed no more than 25% of response, and three patients had no response among them. Conclusion: A synergistic effect has not been observed with DPCP and anthralin in patients with therapy-resistant extensive AA.

A case of lipodystrophy with systemic sclerosis

( Si Hyub Lee ),( Hee Seong Yoon ),( Seung Dohn Yeom ),( Hye Soo Ko ),( Jeong Hyun Shin ),( Gwang Seong Choi ),( Ji Won Byun ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Lipodystrophy is a group of adipose tissue disorders classified into a familial or acquired, generalized or partial loss of adipose tissue. The exact pathogenesis of fat loss remains unclear. Some cases of lipodystrophy has been documented about an association with autoimmune diseases such as dermatomyositis, hypothyroidism, and SLE. We report a case of a 40-year-old woman with systemic sclerosis who has peculiar presentation of partial lipodystrophy. She lost her abdominal fat in her twenties gradually in a symmetric fashion and then presented with prominent bilateral buccal fat atrophy since 2 years ago. The patient had clubbing fingers and showed Raynaud phenomenon. There was no family history of lipodystrophy. The laboratory tests, including complete blood count, urinalysis, liver function test, blood urea nitrogen, serum creatinine, complement 3 were normal. HIV Ag/Ab and circulating immunoglobulin G were absent. Skin biopsy showed thickend and sclerotic dermis with decreased subcutaneous fat. We managed the buccal lipoatrophy with a series of autologous fat transplantations using liposuction aspirate fat from the both thighs and it shows well engraftment for 6 months.